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I think I deeply underestimate the effect of pain on my mental health.

Oftentimes that pain will lead me to seek out medical care.

That medical care will fall short in myriad ways.

The most damage is done when I am treated like I do not know what I am talking about(which I do, it’s my body and I’m a smart cookie).

They go on to not listen or ignore symptoms.

Systemic misgendering.

Ultimately, ineffective treatments and I have wasted hours, expending myself mentally and physically, with nothing new tried, no answers, no treatments, no referrals, no belief that it would improve, a whole mess of micro aggressions, and worsening pain.

I was writing my suicide note in my head while driving home.

I wasn’t worth listening to. I wasn’t worth respecting. I wasn’t worth treating. I was a drain on the system.

A creature of pure torture and it wasn’t going to get better.

Because I will always be the person that writes “LOL” when a form leaves 8 spaces for you to put your medication list.

Because I will need multiple specialists who for some reason can never coordinate their blood work requests.

Because the combined costs for the surgeries I will need to no longer squirm like a child at a funeral just at the idea of being in my body exceeds that of most suburban homes.

Because I have wanted to die as long as I can remember, and only regular therapy, medication monitoring, inpatient hospitalizations, and the occasional emergency interventions keep it from happening.

So where does that come in with suicide? How many times do you wake someone up with a smile and tell them they aren’t worthless and sit beside them coloring and chatting as they stare off in to space and beg the universe that JUST ONCE someone would have thrown up their hands and said “well I guess they weren’t worth saving after all.” How many times do you say hello and goodbye to the staff that all knew you anyway before the EMT blacklists your house?How many interventions does it take until when a patient says “I’m worthless,” the reply is, “Well, you’ve met your mental health value quota so, yeah, you’ll have to find some worth somewhere else in life. ”

The mental health system is slow, toxically still full of stigma, and prey to every -ism.

But here I am still.

I was past three strikes years ago, folks.

I thought a line should go in my suicide note- “In lieu of flowers, please send letters to local hospitals and your congressmen.”

I came up with some clever lines. Even some stuff about the selfishness of suicide.
Because it’s not. It’s not about you, and you’re being arrogant if you think that. If anything, it’s selfish of you for wanting to keep someone who is suffering that much around, just so you can feel marginally better.

Things like that mindset guarantee I’m not pleasant to be around, I’m pretty sure I don’t have all that many friends, mostly acquaintances.

I thought about the funeral. It’d probably be at the church I grew up in and was chronically awkward in. The one that was 400 people that met in a pole barn when I was 2 and vomited on someone’s shoes and will never live down. I was there as it expanded. As it moved. As it kept rejecting me socially. I was there for the newest addition, millions upon millions of dollars raised. I toured it it when it was scaffolding, sheets of plastic and exposed concrete. I watched as it stretched a video outreach across the globe and my father would occasionally do some paint touch up work on the pastor’s massive boat.

Somehow non-denominational is its own particular denomination. Whodathunkit, it has some very traditional and conservative mindsets.

I knew that without a legally changed name and gender marker, I would be deadnamed among my family until we were all dirt.

And when I came out as pansexual I was told that “a line has been crossed in the eyes of God” if I would ever touch a woman.

And when I came out as transgender I was told that “this was an exploration” and “I will find a revelation.”

“God loves her more than we love her.”

You can change if it’s supposed to cut or be supportive depending on what you emphasize.

My dad had said in the session with my therapist that I have an “emotionally built feminine psyche” and that “guys don’t deal with these emotions.” He figured that a part of my transition goal was to get over trauma through that reasoning. He also said he has nothing but compassion for those that are internally conflicted, which I have been for a very long time.

He challenged me to find one person who was truly happy having done this, 10 years out, figuring that anyone who was transgender would just be so conflicted that they’d never really improve their lives.

Months later my mother was teary eyed when she asked me if I thought I was still saved.

She said “I have to hold onto the thought that you might still be in heaven.”

I wondered at the hellfire that was currently eating her alive, fresh and meaty and ripe, right on this plane of existence.

I thought of all this while I plotted my suicide note. The idea I could be so wrong, so broken that I would be cursed to brimstone and damnation had such a hold on her heart. I fumed.

I spewed. You know, in my head.

Then I craved. I wanted someone to read the note at my funeral. Read the note at the church I was raised in.

I wanted someone to tell them that this is not the gospel. Christ’s blood was spilled so no more has to be.

I got home.

I took some medication.

I pet fuzzy animals.

I relaxed on the bed.

I felt a little bit better.

Then I got angry.

Angry enough to do some good.

When you are low enough that you’ve almost stopped feeling bad, stopped feeling anything, you can find angry.

You can tap into it.

I realized that no one is going to do my advocacy for me.

I may already be fighting hard.

I will have to fight every damn day.

And it will keep hurting.

But I can’t give up and leave my mantle for another, they must carry their own.

And these *very expensive* pills are to blame for that. They can be a bit of a curse. It’s obnoxious to go pick them up all the time, my insurance doesn’t allow the pharmacy’s prescription syncing service because they hate progress or something. It takes me about an hour and a half for me to watch a comedy special and prepare the next three weeks of pill cases. It’d take less time if I were singularly focused, yes, but I’d also get so angry that I’d probably start chucking pills at passing cars. Truly though, cars don’t pass by my apartment often enough to let out that rage so I might feebly try to anger-juggle the bottles or some shit like that.

I used to swallow pills one at a time.
A few overdose attempts and having a regimen like this managed to train me out of that.

I also used to swallow Cheerios like pills when I was a kid. I’m not exactly sure why I felt I needed the practice, but I can’t argue with the results. I’m a real pro.

My psychiatrist appointment yesterday brought up my starting Testosterone. It all had happened so quickly, that he hadn’t even been informed yet. He was definitely surprised, but also said, “well maybe we’ve hit a root issue here and once you’re further along, we can start to back you off on stuff again.” That’d be nice. Maybe regular human doses and such!

A few months ago I weaned off Abilify because of drowsiness and weight. It went fine for awhile, then I tanked. So we are trying its new big brother, Rexulti, which is more potent so you take a lower dose and get less side effects. It’s also retails at around $1,100.

Yeah, I want off meds. It sucks that I have to take them. However, I have confronted the fact that I do not have a normal brain. I will never be able to be free of them and have a decent quality of life.

I doubt I’d be able to go off them for 6 months and physically survive, actually.

So, 23 pills and a biweekly injection.

I continue into the fray. I depend on them. They are my sword and shield in a harsh forest full of monsters.

When it comes to advocacy and stigma, I won’t say “I am medicated, hear me roar!” I don’t think we need more associations of crazy.